Annual NURSING INSTRUCTOR COMPETENCY PATHWAY

Instructor name
Student Learning & Patient Focus: Demonstrates basic knowledge of system, hospital, and department policies and procedures
Annual Instructor competency requirements are met by completing this form including the annually RN department competencies for the instructor’s clinical department site and as needed for any additional departments the instructor uses for clinicals.
Annual Orientation requirements have been met.
Instructor signature:______Date ______
(CORE Orientation test and Cone Health PP Acknowledgement form on file at school) / School
Date
Department
Competency
Validator’s
Name(s)
QO = Qualified Observer
Staff nurse, co-worker
SE = Self-Evaluation

COMPETENCY

/ LEARNING ACTIVITIES / METHODS OF Validation / QO/ SE Initials & Date
Department Specific
Demonstrates knowledge of:
Scope of service & dept. mission, pt. pop.
Disaster Plan (general in annual Orientation)
Department Quality Improvement Initiatives
Fire Safety (general in annual Orientation)
Annual Department RN Competencies – see page4 / Review scope of service/dept. mission
Read department disaster plan/ department role
Discuss Department Quality Improvement Initiatives
Locate fire exits, fire extinguishers, pull stations, O2 shut-off valves / Verbalizes understanding of:
Scope of service/dept. mission ____/____
Department disaster plan ____/____
Verbalizes Department Quality Improvement Initiatives ___/___
Locates dept fire exits, fire extinguishers, pull stations, & O2 shut-off valves ____/____
Generic Clinical Resources
Patient Education Resources / Discuss use of Exit Care & Patient Education Network / Verbalizes how to instruct students about use of: Exit Care __/__ ;On-Demand Patient Education Network _____/___
Locate on Chart:
Advance Directives
Allergies
Hall Pass / Review Hall Pass Instruction / Verbalizes how to instruct students to find:
Advance Directive information___/__
Allergies____/____
Hall Pass____/____
Demonstrates knowledge of Core Measures:
Pneumonia
Myocardial infarction
Heart Failure
Surgical Care Infection Prevention (SCIP)
VTE / Review education material for Core Measures that are pertinent to your department. (Homepage ->Departments -> Quality Improvement -> Quality Informatics/Core Measure->Useful Links-> “At a Glance” for each Core Measure) / Verbalizes how to instruct students regarding nursing interventions related to Core Measuresthat apply to department. ____/____
Safely operates the following equipment:
Alaris IV pump
Electronic BP Monitor
Safe Patient Handling equipment used on the department
Zoll Defibrillator
Restraints / Practice Alaris IV Pump Functions: Programming
Primary/Secondary Infusions and Channel Labels,
Clearing Pump, Using Guardrails, Administering Boluses
Review operation of Electronic BP Monitor
Review how to use safe patient handling equipment used on department.
Review operation of the Zoll Monitor
Review restraint policy / Demonstrates proper operation of:
Alaris IV pump ____/__
Electronic BP monitor ____/____
Safe patient handling equipment ____/____
Zoll ____/____
Restraint Competency Check-off___/___
Improve the accuracy of patient identification
Improve the safety of using medications
Improve the effectiveness of communication among caregivers
Reduce the risk of patient harm resulting from falls / Review the Nursing and Clinical Student Policy
Review Medication Safety and High Alert Medications Policy
Review Medication Administration and Bar-Code Scanning Policy
(Policies are in the Instructor Reference document.
Adverse drug event reporting and incident reporting/Safety Zone Portal (SZP)
Review the faculty communication requirements (Instructor Reference):
  • Prior to beginning clinical rotation
  • Beginning and end of shift
Patient Safety plan, fall risk scoring, and alternatives to restraints
--Restraints policy & procedure and audit tool / Verbalizes understanding and importance of teaching students about the following Policies:
Nursing and Clinical Student Policy ______/______
Medication Safety and High Alert Medications Policy ______/______
Medication Administration and Bar-Code Scanning Policy ______/______
Safety Zone Portal (SZP) reporting ______/______
Verbalizes understanding and importance of teaching students:
--Patient identification process prior to medication
administration______/______
--Safe patient medication administration______/______
--Medication labeling ______/______
--Dating of multi-dose vial _____/_____
Verbalizeunderstanding of faculty communication requirements::
- Prior to beginning clinical rotation ______/______
- Beginning and end of shift ______/______
Demonstrates ability to review with students:
--Fall risk assessment ___/___
--Restraint Competency Check-off___/___
Discuss alternatives to restraints ____/____
Demonstrates process for involving patients/families in their care_____/______
Demonstrates knowledge of infection prevention
Reduce the risk of healthcare–associated infections (NPSG) / Discuss hand hygiene/cleaning of patient care equipment
Demonstrate infection prevention precautions (isolation types)
 Contact (C. Diff)
  • Contact (VRE, MRSA, Scabies, Chicken Pox)
 Airborne
 Neutropenic
  • Droplet
Review Infection Prevention Policies regarding patient isolation / Verbalizes understanding of and importance of instructing students regarding:
appropriate hand hygiene______/______
infection prevention precautions ____/____
Demonstrates knowledge of early activation of Emergency Response Teams
Improve recognition and response to changes in patient condition (NPSG)
  • Code Blue
  • Rapid Response Team (RRT)
  • Code Stroke
/ Know how to recognize the event and call for help / Verbalizes how to recognize the event and call for help
Demonstrates operation of AED___/___

Annual Instructor Department Specific Competency Validation Form

Required annually and for every department the instructor uses within the year.

Name: ______School ______Campus / Department ______Date: ______

Competency / Method / Date / Staff Nurse / Qualified Observer/ Clinical Education Coordinator or Self-Eval / Comments
1
2
3
4
5
6
7

Methods: DO= Department OrientationAS= competency met through instructor’s work at the Academic Site CHE= competency met as a Cone Health employee

PK = current Knowledge gained inPrevious instructor role NA=department competency is Not Applicable to the Instructor role

Evaluation:

Staff Nurse / Preceptor/ Qualified Observer / or Clinical Education Coordinator (CEC) Comments:

Instructor Comments: ______

______

______

Signature of Staff Nurse / Preceptor/ Qualified Observer / or Clinical Education Coordinator:

Signature of Instructor:

Date:

Nursing InstructorAnnual Department Competency Pathway 8.15

Adapted from RN Orientation pathway.Revised-5-13